Pharmacy Practice Faculty Publications
Assessment of Clinical Inertia in People with Diabetes Within Primary Care
Document Type
Article
Publication Date
4-2021
Journal Title
Journal of Evaluation in Clinical Practice
Volume
27
Issue
2
DOI
10.1111/jep.13429
Abstract
Rationale, aims and objectives
Clinical inertia, defined as a delay in treatment intensification, is prevalent in people with diabetes. Treatment intensification rates are as low as 37.1% in people with haemoglobin A1c (HbA1c) values >7%. Intensification by addition of medication therapy may take 1.6 to more than 7 years. Clinical inertia increases the risk of cardiovascular events. The primary objective was to evaluate rates of clinical inertia in people whose diabetes is managed by both pharmacists and primary care providers (PCPs). Secondary objectives included characterizing types of treatment intensification, HbA1c reduction, and time between treatment intensifications.
Method
Retrospective chart review of persons with diabetes managed by pharmacists at an academic, safety‐net institution. Eligible subjects were referred to a pharmacist‐managed cardiovascular risk reduction clinic while continuing to see their PCP between October 1, 2016 and June 30, 2018. All progress notes were evaluated for treatment intensification, HbA1c value, and type of medication intensification.
Results
Three hundred sixty‐three eligible patients were identified; baseline HbA1c 9.6% (7.9, 11.6) (median interquartile range [IQR]). One thousand one hundred ninety‐two pharmacist and 1739 PCP visits were included in data analysis. Therapy was intensified at 60.5% (n = 721) pharmacist visits and 39.3% (n = 684) PCP visits (P < .001). The median (IQR) time between interventions was 49 (28, 92) days for pharmacists and 105 (38, 182) days for PCPs (P < .001). Pharmacists more frequently intensified treatment with glucagon‐like peptide‐1 agonists and sodium glucose cotransporter‐2 inhibitors.
Conclusion
Pharmacist involvement in diabetes management may reduce the clinical inertia patients may otherwise experience in the primary care setting.
Keywords
Clinical inertia, diabetes mellitus, pharmacists, primary care
Recommended Citation
Meredith, Ashley H.; Buatois, Emily M.; Krenz, James R.; Walroth, Todd; Shenk, McKenzie; Triboletti, Jessica S.; Pence, Lauren; and Gonzalvo, Jasmine D., "Assessment of Clinical Inertia in People with Diabetes Within Primary Care" (2021). Pharmacy Practice Faculty Publications. 421.
https://digitalcommons.cedarville.edu/pharmacy_practice_publications/421